MEDICAL EVIDENCE

The DDS is responsible for developing a claimant’s medical history for at least the previous 12 months in most claims. This includes statements or reports from the claimant or his treating source, and information about the impact of an impairment and its related symptoms on a claimant’s ability to work. Every reasonable effort is made to obtain medical reports from the claimant’s treating source or other medical sources. The DDS evaluates every medical opinion received regardless of source, but does not have to give every opinion equal weight. The treating source is given “controlling weight” if the opinion is well supported by medically acceptable clinical and laboratory diagnostic techniques and is not inconsistent with other substantial evidence in the case record.

If the treating source’s report contains a conflict or ambiguity that must be resolved, lacks necessary information, or does not appear to be based on medically acceptable clinical and laboratory diagnostic techniques, the DDS may recontact the treating source for additional evidence or clarification. If the treating source will not or cannot provide the information needed to decide the case, the DDS can order and pay for a consultative examination.

“Acceptable medical sources” are sources who can provide evidence to establish a medically determinable impairment (see Box 1-1). The term

BOX 1-1

Acceptable Medical Sources

  • Licensed physicians (medical or osteopathic doctors)

  • Licensed or certified psychologists (included are school psychologists or other licensed or certified individuals with other titles who perform the same function as a school psychologist in a school setting, for purposes of establishing mental retardation, learning disabilities, and borderline intellectual functioning only)

  • Licensed optometrists, for purposes of establishing visual disorders (except in the U.S. Virgin Islands, licensed optometrists, for the measurement of visual acuity and visual fields only)

  • Licensed podiatrists, for purposes of establishing impairments of the foot, or foot and ankle only, depending on whether the state in which the podiatrist practices permits the practice of podiatry on the foot only, or the foot and ankle

  • Qualified speech-language pathologists, for purposes of establishing speech or language impairments only (“qualified” means that the speech-language pathologist must be licensed by the state professional licensing agency, or be fully certified by the state education agency in the state in which he practices, or hold a Certificate of Clinical Competence from the American Speech-Language-Hearing Association)



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